tbuckley/cabot-search huggingface dataset:
Comparison of short term surgical outcomes of male and female gastrointestinal surgeons in Japan: retrospective cohort study
Authors: Kae Okoshi, Hideki Endo, Sachiyo Nomura, Emiko Kono, Yusuke Fujita, Itaru Yasufuku, Koya Hida, Hiroyuki Yamamoto, Hiroaki Miyata, Kazuhiro Yoshida, Yoshihiro Kakeji, Yuko Kitagawa
Journal: BMJ (2022)

To compare short term surgical outcomes between male and female gastrointestinal surgeons in Japan. Retrospective cohort study. Data from the Japanese National Clinical Database (includes data on >95% of surgeries performed in Japan) (2013-17) and the Japanese Society of Gastroenterological Surgery. Male and female surgeons who performed distal gastrectomy, total gastrectomy, and low anterior resection. Surgical mortality, surgical mortality combined with postoperative complications, pancreatic fistula (distal gastrectomy/total gastrectomy only), and anastomotic leakage (low anterior resection only). The association of surgeons' gender with surgery related mortality and surgical complications was examined using multivariable logistic regression models adjusted for patient, surgeon, and hospital characteristics. A total of 149 193 distal gastrectomy surgeries (male surgeons: 140 971 (94.5%); female surgeons: 8222 (5.5%)); 63 417 gastrectomy surgeries (male surgeons: 59 915 (94.5%); female surgeons: 3502 (5.5%)); and 81 593 low anterior resection procedures (male surgeons: 77 864 (95.4%);female surgeons: 3729 (4.6%)) were done. On average, female surgeons had fewer post-registration years, operated on patients at higher risk, and did fewer laparoscopic surgeries than male surgeons. No significant difference was found between male and female surgeons in the adjusted risk for surgical mortality (adjusted odds ratio 0.98 (95% confidence interval 0.74 to 1.29) for distal gastrectomy; 0.83 (0.57 to 1.19) for total gastrectomy; 0.56 (0.30 to 1.05) for low anterior resection), surgical mortality combined with Clavien-Dindo grade ≥3 complications (adjusted odds ratio 1.03 (0.93 to 1.14) for distal gastrectomy; 0.92 (0.81 to 1.05) for total gastrectomy; 1.02 (0.91 to 1.15) for low anterior resection), pancreatic fistula (adjusted odds ratio 1.16 (0.97 to 1.38) for distal gastrectomy; 1.02 (0.84 to 1.23) for total gastrectomy), and anastomotic leakage (adjusted odds ratio 1.04 (0.92 to 1.18) for low anterior resection). This study found no significant adjusted risk difference in the outcomes of surgeries performed by male versus female gastrointestinal surgeons. Despite disadvantages, female surgeons take on patients at high risk. Greater access to surgical training for female physicians is warranted in Japan.
Devolution of public services in Manchester led to modest improvement in life expectancy, study shows
Authors: Adrian O’Dowd
Journal: BMJ (2022)

<h3>Objective</h3> To identify underlying genetic causes in patients with pediatric movement disorders by genetic investigations. <h3>Methods</h3> All patients with a movement disorder seen in a single Pediatric Genetic Movement Disorder Clinic were included in this retrospective cohort study. We reviewed electronic patient charts for clinical, neuroimaging, biochemical, and molecular genetic features. DNA samples were used for targeted direct sequencing, targeted next-generation sequencing, or whole exome sequencing. <h3>Results</h3> There were 51 patients in the Pediatric Genetic Movement Disorder Clinic. Twenty-five patients had dystonia, 27 patients had ataxia, 7 patients had chorea-athetosis, 8 patients had tremor, and 7 patients had hyperkinetic movements. A genetic diagnosis was confirmed in 26 patients, including in 20 patients with ataxia and 6 patients with dystonia. Targeted next-generation sequencing panels confirmed a genetic diagnosis in 9 patients, and whole exome sequencing identified a genetic diagnosis in 14 patients. <h3>Conclusions</h3> We report a genetic diagnosis in 26 (51%) patients with pediatric movement disorders seen in a single Pediatric Genetic Movement Disorder Clinic. A genetic diagnosis provided either disease-specific treatment or effected management in 10 patients with a genetic diagnosis, highlighting the importance of early and specific diagnosis.
Effectiveness of a behavioural intervention delivered by text messages (safetxt) on sexually transmitted reinfections in people aged 16-24 years: randomised controlled trial
Authors: Caroline Free, Melissa J Palmer, Ona L McCarthy, Lauren Jerome, Sima Berendes, Megan Knight, James R Carpenter, Tim P Morris, Zahra Jamal, Farandeep Dhaliwal, Rebecca S French, Ford Colin Ian Hickson, Anasztazia Gubijev, Kaye Wellings, Paula Baraitser, Ian Roberts, Julia V Bailey, Tim Clayton, Karen Devries, Phil Edwards, Graham Hart, Susan Michie, Louis Macgregor, Katy M E Turner, Kimberley Potter
Journal: BMJ (2022)

Abstract Objective To quantify the effects of a series of text messages (safetxt) delivered in the community on incidence of chlamydia and gonorrhoea reinfection at one year in people aged 16-24 years. Design Parallel group randomised controlled trial. Setting 92 sexual health clinics in the United Kingdom. Participants People aged 16-24 years with a diagnosis of, or treatment for, chlamydia, gonorrhoea, or non-specific urethritis in the past two weeks who owned a mobile phone. Interventions 3123 participants assigned to the safetxt intervention received a series of text messages to improve sex behaviours: four texts daily for days 1-3, one or two daily for days 4-28, two or three weekly for month 2, and 2-5 monthly for months 3-12. 3125 control participants received a monthly text message for one year asking for any change to postal or email address. It was hypothesised that safetxt would reduce the risk of chlamydia and gonorrhoea reinfection at one year by improving three key safer sex behaviours: partner notification at one month, condom use, and sexually transmitted infection testing before unprotected sex with a new partner. Care providers and outcome assessors were blind to allocation. Main outcome measures The primary outcome was the cumulative incidence of chlamydia or gonorrhoea reinfection at one year, assessed by nucleic acid amplification tests. Safety outcomes were self-reported road traffic incidents and partner violence. All analyses were by intention to treat. Results 6248 of 20 476 people assessed for eligibility between 1 April 2016 and 23 November 2018 were randomised. Primary outcome data were available for 4675/6248 (74.8%). At one year, the cumulative incidence of chlamydia or gonorrhoea reinfection was 22.2% (693/3123) in the safetxt arm versus 20.3% (633/3125) in the control arm (odds ratio 1.13, 95% confidence interval 0.98 to 1.31). The number needed to harm was 64 (95% confidence interval number needed to benefit 334 to ∞ to number needed to harm 24) The risk of road traffic incidents and partner violence was similar between the groups. Conclusions The safetxt intervention did not reduce chlamydia and gonorrhoea reinfections at one year in people aged 16-24 years. More reinfections occurred in the safetxt group. The results highlight the need for rigorous evaluation of health communication interventions. Trial registration ISRCTN registry ISRCTN64390461 .
Contribution of smoking towards the association between socioeconomic position and dementia: 32-year follow-up of the Whitehall II prospective cohort study
Authors: Martina Raggi, Aline Dugravot, Linda Valeri, Marcos D. Machado-Fragua, Julien Dumurgier, Mika Kivimaki, Séverine Sabia, Archana Singh-Manoux
Journal: The Lancet Regional Health - Europe (2022)

There is consistent evidence of social inequalities in dementia but the mechanisms underlying this association remain unclear. We examined the role of smoking in midlife in socioeconomic differences in dementia at older ages.Analyses were based on 9951 (67% men) participants, median age 44.3 [IQR=39.6, 50.3] years at baseline in 1985-1988, from the Whitehall II cohort study. Socioeconomic position (SEP) and smoking (smoking status (current, ex-, never-smoker), pack years of smoking, and smoking history score (combining status and pack-years)) were measured at baseline. Counterfactual mediation analysis was used to examine the contribution of smoking to the association between SEP and dementia.During a median follow-up of 31.6 (IQR 31.1, 32.6) years, 628 participants were diagnosed with dementia and 2110 died. Analyses adjusted for age, sex, ethnicity, education, and SEP showed smokers (hazard ratio [HR] 1.36 [95% CI 1.10-1.68]) but not ex-smokers (HR 0.95 [95% CI 0.79-1.14]) to have a higher risk of dementia compared to never-smokers; similar results for smoking were obtained for pack-years of smoking and smoking history score. Mediation analysis showed low SEP to be associated with higher risk of dementia (HRs between 1.97 and 2.02, depending on the measure of smoking in the model); estimate for the mediation effect was 16% for smoking status (Indirect Effect HR 1.09 [95% CI 1.03-1.15]), 7% for pack-years of smoking (Indirect Effect HR 1.03 [95% CI 1.01-1.06]) and 11% for smoking history score (Indirect Effect HR 1.06 [95% CI 1.02-1.10]).Our findings suggest that part of the social inequalities in dementia is mediated by smoking.NIH.
Letter to the Editor: Predicting mortality after transjugular intrahepatic portosystemic shunt in older adult patients with cirrhosis—Does novelty supplant the standard?
Authors: Karl Vaz, Robert Little, Ammar Majeed, Stuart Roberts, William Kemp
Journal: Hepatology (2022)

Vaz, Karl; Little, Robert; Majeed, Ammar; Roberts, Stuart; Kemp, William Author Information
Cost-effectiveness of an Emergency Department–Based Intensive Care Unit
Authors: Benjamin S. Bassin, Nathan L. Haas, Nana Sefa, Richard Medlin, Timothy A. Peterson, Kyle Gunnerson, Steve Maxwell, James A. Cranford, Stephanie Laurinec, Christine Olis, Renee Havey, Robert Loof, Patrick Dunn, Debra Burrum, Jennifer Gegenheimer-Holmes, Robert W. Neumar
Journal: JAMA Network Open (2022)

Importance Value in health care is quality per unit cost (V = Q/C), and an emergency department–based intensive care unit (ED-ICU) model has been associated with improved quality. To assess the value of this care delivery model, it is essential to determine the incremental direct cost of care. Objective To determine the association of an ED-ICU with inflation-adjusted change in mean direct cost of care, net revenue, and direct margin per ED patient encounter. Design, Setting, and Participants This retrospective economic analysis evaluated the cost of care delivery to patients in the ED before and after deployment of the Joyce and Don Massey Family Foundation Emergency Critical Care Center, an ED-ICU, on February 16, 2015, at a large academic medical center in the US with approximately 75 000 adult ED visits per year. The pre–ED-ICU cohort was defined as all documented ED visits by patients 18 years or older with a complete financial record from September 8, 2012, through June 30, 2014 (660 days); the post–ED-ICU cohort, all visits from July 1, 2015, through April 21, 2017 (660 days). Fiscal year 2015 was excluded from analysis to phase in the new care model. Statistical analysis was performed March 1 through December 30, 2021. Exposures Implementation of an ED-ICU. Main Outcomes and Measures Inflation-adjusted direct cost of care, net revenue, and direct margin per patient encounter in the ED. Results A total of 234 884 ED visits during the study period were analyzed, with 115 052 patients (54.7% women) in the pre–ED-ICU cohort and 119 832 patients (54.5% women) in the post–ED-ICU cohort. The post–ED-ICU cohort was older (mean [SD] age, 49.1 [19.9] vs 47.8 [19.6] years; P &amp;amp;lt; .001), required more intensive respiratory support (2.2% vs 1.1%; P &amp;amp;lt; .001) and more vasopressor use (0.5% vs 0.2%; P &amp;amp;lt; .001), and had a higher overall case mix index (mean [SD], 1.7 [2.0] vs 1.5 [1.7]; P &amp;amp;lt; .001). Implementation of the ED-ICU was associated with similar inflation-adjusted total direct cost per ED encounter (pre–ED-ICU, mean [SD], $4875 [$15 175]; post–ED-ICU, $4877 [$17 400]; P = .98). Inflation-adjusted net revenue per encounter increased by 7.0% (95% CI, 3.4%-10.6%; P &amp;amp;lt; .001), and inflation-adjusted direct margin per encounter increased by 46.6% (95% CI, 32.1%-61.2%; P &amp;amp;lt; .001). Conclusions and Relevance Implementation of an ED-ICU was associated with no significant change in inflation-adjusted total direct cost per ED encounter. Holding delivery costs constant while improving quality demonstrates improved value via the ED-ICU model of care.
Long-term quality of life, work limitation, physical activity, economic cost and disease burden following ACL and meniscal injury: a systematic review and meta-analysis for the OPTIKNEE consensus
Authors: Stephanie Rose Filbay, Søren T Skou, Garrett S Bullock, Christina Y Le, Anu M Räisänen, Clodagh Toomey, Allison M Ezzat, Alix Hayden, Adam G Culvenor, Jackie L Whittaker, Ewa M Roos, Kay M Crossley, Carsten Bogh Juhl, Carolyn Emery
Journal: British Journal of Sports Medicine (2022)

Objective Determine the long-term health-related quality-of-life (HRQoL), work limitation, physical activity, health/economic cost and disease burden of traumatic ACL and/or meniscal injury. Findings will inform OPTIKNEE evidence-based consensus recommendations. Design Random-effects meta-analysis evaluated HRQoL (SF-36/SF-12/VR-12 Physical Component Scores (PCS) and Mental Component Scores (MCS), EuroQol-5D (EQ-5D)) stratified by time postinjury, and pooled mean differences (95% CI) between ACL-injured and uninjured controls. Other outcomes were synthesised descriptively. Risk-of-bias (RoB) and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation) were assessed. Data sources MEDLINE, EMBASE, CENTRAL, SPORTDiscus, CINAHL searched inception: 22 November 2021. Eligibility Studies reporting HRQoL, work limitations, physical activity levels, health/economic costs or disease burden, ≥2 years post-ACL and/or meniscal injury. Results Fifty studies were included (10 high-RoB, 28 susceptible-to-some-bias and 12 low-RoB). Meta-analysis (27 studies, very low certainty of evidence) estimated a pooled mean (95% CI) PCS of 52.4 (51.4 to 53.4) and MCS of 54.0 (53.0 to 55.0) 2–14 years post-ACL injury. Pooled PCS scores were worse &gt;10 years (50.8 (48.7 to 52.9)) compared with 2–5 years (53.9 (53.1 to 54.7)) postinjury. Excluding high-RoB studies, PCS scores were worse in ACL-injured compared with uninjured controls (−1.5 (−2.9 to –0.1)). Six studies (low certainty of evidence) informed a pooled EQ-5D score of 0.83 (0.81 to 0.84). Some individuals experienced prolonged work absenteeism and modified activities ≥2 years post-ACL injury. ACL injury was associated with significant direct and indirect costs, and early ACL reconstruction may be less cost-effective than rehabilitation. Only three studies evaluated meniscal injury outcomes (all evaluated HRQoL). Conclusion There is a very-low certainty of evidence that PCS scores ≥2 years post-ACL injury are worse than uninjured controls and decline over time, whereas MCS scores remain high. ACL injury can result in prolonged work absenteeism and high health/economic costs. Further studies are needed to determine the long-term burden of traumatic meniscal injury.
Deciphering the role of cDC2s in Sjögren’s syndrome: transcriptomic profile links altered antigen processes with IFN signature and autoimmunity
Authors: Ana P Lopes, Maarten R Hillen, Anneline C Hinrichs, Sofie LM Blokland, Cornelis PJ Bekker, Aridaman Pandit, Aike A Kruize, Timothy RDJ Radstake, Joel A van Roon
Journal: Annals of the Rheumatic Diseases (2022)

Objective Type 2 conventional dendritic cells (cDC2s) are key orchestrators of inflammatory responses, linking innate and adaptative immunity. Here we explored the regulation of immunological pathways in cDC2s from patients with primary Sjögren’s syndrome (pSS). Methods RNA sequencing of circulating cDC2s from patients with pSS, patients with non-Sjögren’s sicca and healthy controls (HCs) was exploited to establish transcriptional signatures. Phenotypical and functional validation was performed in independent cohorts. Results Transcriptome of cDC2s from patients with pSS revealed alterations in type I interferon (IFN), toll-like receptor (TLR), antigen processing and presentation pathways. Phenotypical validation showed increased CX3CR1 expression and decreased integrin beta-2 and plexin-B2 on pSS cDC2s. Functional validation confirmed impaired capacity of pSS cDC2s to degrade antigens and increased antigen uptake, including self-antigens derived from salivary gland epithelial cells. These changes in antigen uptake and degradation were linked to anti-SSA/Ro (SSA) autoantibodies and the presence of type I IFNs. In line with this, in vitro IFN-α priming enhanced the uptake of antigens by HC cDC2s, reflecting the pSS cDC2 profile. Finally, pSS cDC2s compared with HC cDC2s increased the proliferation and the expression of CXCR3 and CXCR5 on proliferating CD4 + T cells. Conclusions pSS cDC2s are transcriptionally altered, and the aberrant antigen uptake and processing, including (auto-)antigens, together with increased proliferation of tissue-homing CD4 + T cells, suggest altered antigen presentation by pSS cDC2s. These functional alterations were strongly linked to anti-SSA positivity and the presence of type I IFNs. Thus, we demonstrate novel molecular and functional pieces of evidence for the role of cDC2s in orchestrating immune response in pSS, which may yield novel avenues for treatment.
Postinfective bowel dysfunction following<i>Campylobacter enteritis</i>is characterised by reduced microbiota diversity and impaired microbiota recovery
Authors: Jonna Jalanka, David Gunn, Gulzar Singh, Shanthi Krishnasamy, Melanie Lingaya, Fiona Crispie, Laura Finnegan, Paul Cotter, Louise James, Adam Nowak, Giles Major, Robin C Spiller
Journal: Gut (2022)

Objectives Persistent bowel dysfunction following gastroenteritis (postinfectious (PI)-BD) is well recognised, but the associated changes in microbiota remain unclear. Our aim was to define these changes after gastroenteritis caused by a single organism, Campylobacter jejuni , examining the dynamic changes in the microbiota and the impact of antibiotics. Design A single-centre cohort study of 155 patients infected with Campylobacter jejuni . Features of the initial illness as well as current bowel symptoms and the intestinal microbiota composition were recorded soon after infection (visit 1, &lt;40 days) as well as 40–60 days and &gt;80 days later (visits 2 and 3). Microbiota were assessed using 16S rRNA sequencing. Results PI-BD was found in 22 of the 99 patients who completed the trial. The cases reported significantly looser stools, with more somatic and gastrointestinal symptoms. Microbiota were assessed in 22 cases who had significantly lower diversity and altered microbiota composition compared with the 44 age-matched and sex-matched controls. Moreover 60 days after infection, cases showed a significantly lower abundance of 23 taxa including phylum Firmicutes, particularly in the order Clostridiales and the family Ruminoccocaceae, increased Proteobacteria abundance and increased levels of Fusobacteria and Gammaproteobacteria. The microbiota changes were linked with diet; higher fibre consumption being associated with lower levels of Gammaproteobacteria. Conclusion The microbiota of PI-BD patients appeared more disturbed by the initial infection compared with the microbiota of those who recovered. The prebiotic effect of high fibre diets may inhibit some of the disturbances seen in PI-BD. Trial registration number NCT02040922 .
Low copy numbers of complement<i>C4</i>and<i>C4A</i>deficiency are risk factors for myositis, its subgroups and autoantibodies
Authors: Danlei Zhou, Emily H King, Simon Rothwell, Olga Krystufkova, Antonella Notarnicola, Samantha Coss, Rabheh Abdul-Aziz, Katherine E Miller, Amanda Dang, G Richard Yu, Joanne Drew, Emeli Lundström, Lauren M Pachman, Gulnara Mamyrova, Rodolfo V Curiel, Boel De Paepe, Jan L De Bleecker, Antony Payton, William Ollier, Terrance P O'Hanlon, Ira N Targoff, Willy A Flegel, Vidya Sivaraman, Edward Oberle, Shoghik Akoghlanian, Kyla Driest, Charles H Spencer, Yee Ling Wu, Haikady N Nagaraja, Stacy P Ardoin, Hector Chinoy, Lisa G Rider, Frederick W Miller, Ingrid E Lundberg, Leonid Padyukov, Jiří Vencovský, Janine A Lamb, Chack-Yung Yu
Journal: Annals of the Rheumatic Diseases (2022)

Idiopathic inflammatory myopathies (IIM) are a group of autoimmune diseases characterised by myositis-related autoantibodies plus infiltration of leucocytes into muscles and/or the skin, leading to the destruction of blood vessels and muscle fibres, chronic weakness and fatigue. While complement-mediated destruction of capillary endothelia is implicated in paediatric and adult dermatomyositis, the complex diversity of complement
Bioinspired Soft Robotics: How Do We Learn From Creatures?
Authors: Yang Yang, Zhiguo He, Pengcheng Jiao, Hongliang Ren
Journal: IEEE Reviews in Biomedical Engineering (2022)

Soft robotics has opened a unique path to flexibility and environmental adaptability, learning from nature and reproducing biological behaviors. Nature implies answers for how to apply robots to real life. To find out how we learn from creatures to design and apply soft robots, in this Review, we propose a classification method to summarize soft robots based on different functions of biological systems: self-growing, self-healing, self-responsive, and self-circulatory. The bio-function based classification logic is presented to explain <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">why</i> we learn from creatures. State-of-art technologies, characteristics, pros, cons, challenges, and potential applications of these categories are analyzed to illustrate <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">what</i> we learned from creatures. By intersecting these categories, the existing and potential bio-inspired applications are overviewed and outlooked to finally find the answer, that is, <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">how</i> we learn from creatures.